Saturday, May 28, 2005

More on Lay Interference

Neil Whipkey, a recent advocate of single payer in this space, weighs in on the subject of lay interference. What he says is not new to health care executives but he puts it succinctly and readers not so intimately involved in health care may find it informative.

For the most part, healthcare leaders are lay people. That may account, to a small extent, why some are reluctant to be more assertive in addressing clinical problems.

I believe there are other reasons which play a more significant role in the executive's decision to "look the other way". Two of the reasons are related to the fear factor(s). Fear factor #1 is: A totally disorganized medical staff can organize in a heartbeat, once they have determined the administrator needs to go. Reality is that all too often they can and do make this scenario happen, especially if they believe one of their colleagues is under the microscope for clinical shortcomings. Fear factor #1 results in fear of instant job loss. Fear factor #2 is: Any investigation into clinical issues may see your number one admitting physician pack up and go across town. This can play out along the same lines as fear factor #1 with the difference being that in fear factor #2 the "posse" will be the hospital board. In either case it can have the same result.

Factor #3 is: the Amoeba virus (instant loss of backbone). However, the Amoeba virus can often serve as an antidote for the previous two fear factors. The truth is those executives who resort to the Amoeba antidote will find themselves in the Jekyll/Hyde syndrome. Each use of the antidote will result in less and less protection. In the end the result is the same, one posse or the other will get the executive out of town.

There is a way for the health care executive to meet this challenge and his responsibility to the patients. Do your homework, enlist the support of some champions from the medical staff, and have a process that is consistent, fair, and objective. The process is the most important piece and it is the process that needs to be protected (not the administrator or physician). With that said the executive has to play the dual role of advocating both for the physician under review and the patient who got less than the acceptable standard of care. If your process is sound you (the administrator), the physician, and the patient will all be protected and the right thing will be done. Good luck.

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